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Bruna Mayara Rocha Garcia
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EP1.04 - Immuno-oncology (ID 194)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Immuno-oncology
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.04-32 - Successful Corneal Transplantation in a Patient Treated with Nivolumab for Metastatic Non-Small Cell Lung Cancer (ID 227)
08:00 - 18:00 | Author(s): Bruna Mayara Rocha Garcia
- Abstract
Background
Survival improvement in metastatic non-small cell lung cancer has been achieved with the use of checkpoint inhibitors. PD1/PD-L1 pathway is related to immune response and tolerance, so its blockage could predispose to graft rejection. In the pivotal studies of novel immunotherapy, patients submitted to organ transplantation were classically excluded, and scarce data on medical literature exits about graft and patient outcomes in a scenario of use of checkpoint inhibitors in this patientes.
Method
We report the case of a 58 years old man treated with nivolumab for metastatic non-small cell lung cancer, after received platinum-based doublet chemotherapy, docetaxel and erlotinib and that was submitted to a corneal transplantation during the nivolumab treatment.
Result
The patient received Nivolumab 3mg/kg intravenously every two weeks and had stable disease accessed by RECIST 1.1 after 54 cycles and keeped ECOG 0 performance status. This man had a previous history of vision impairment on right eye because of bullous keratopathy after vitrectomy for vitreoretinal disorder, whose treatment of choice is corneal transplantation.
After multidisciplinary discussion, the nivolumab was stopped 2 weeks before the corneal graft was successfully performed. The patient received systemic corticosteroid treatment with prednisone at 10mg daily dose for 10 days and topical dexamethasone for 45 days after procedure. Nivolumab was initiated 3 weeks later. The patient has currently received 68 cycles of nivolumab, CT scan shows stable disease. In the recent ophthalmologic examinatio, there were no sign of chorneal rejection and ocurred an improvement of visual function on right eye (counts fingers in a 2 metes distance).
In the literature, there are with few reports of graft outcomes in a scenario of threatment with chekpoint inhibitors, since this patients were not included in clinical trials. Diverse outcomes are reported ,with a substancial risk of rejection, specially with the use of PD-1/PD-L1 inhibitors in comparison with agents anti -CTLA-4.
In our knowledge, this is the first reported case of a graft transplantation during checkpoint inhibitors therapy.
Conclusion
Immunotheray in this special popullation is usually not recommended and under studied.
In a context of immunotherapy, corneal graft transplantation can be associated with favourable outcomes due to devoid of vasculature and lymphatics in this tissue, that can facilitate immunological tolerance. So, although the risk of rejection must be taken into account, the treatment with anti-PD1 could not be considered an absolute contraindication to corneal transplantation, specially in patients with amaurosis, whose the risk of rejection of a graft cannot induce more damage than is already installed.
